Meeting the Home Adaptation Needs of Older People

Meeting the home adaptation needs of older people Is your council actively addressing residents’ need for help with home adaptations?

Guidance

Foreword

We are delighted that the Local Government Association (LGA), the Association of Directors of Adult Social Services (ADASS), Age UK and Care & Repair England have worked together to produce this guide on home adaptations.

We wrote this publication before the COVID-19 pandemic but the learning in this guide feels even more relevant after the experience of supporting our residents at the height of the crisis, and as we plan for potential further local outbreaks.

Councils have always wanted their residents to live in safe, affordable, good quality homes. COVID-19 has further shown the centrality of housing as a key component of health and care and the foundation upon which people can achieve a positive quality of life. The impact of poor housing on health is similar to that of smoking or alcohol and costs the NHS at least £1.4 billion a year, as well as increasing demand for social care.1 Our ageing population means that older people (over 65s) are making up a growing part of our housing market. They now live in a third of all homes, and this is set to increase in the coming years. Currently, over 90 per cent of older people live in mainstream homes and 80 per cent of the homes we will be living in by 2050 are already built.2 As a society and as individuals, we need to improve the way we plan for old age, and this includes how we house our older people. Whilst there is an undersupply of fully accessible homes, with just seven per cent of the stock meeting the four ‘visitable’ criteria, 72 per cent could be adapted.3 Learning highlighted in this publication shows that timely adaptations can make a real difference to people’s wellbeing, enabling them to stay in their own home when that is their wish. This is especially important given that some groups of people, including those with underlying health conditions and older people, are more vulnerable to COVID-19.

Councils have responsibilities for planning, housing, social care and public health. Through health and wellbeing boards, councils are uniquely placed to bring health and housing partners together to plan for how best to meet the housing needs of our ageing population. This includes ensuring that older and disabled people of all ages, including children, can access the practical help they need to adapt their homes. Although our focus here is on adaptations, councils know that it is just as important to support people to live healthier lives by helping them to address problems such as damp and cold homes.

1 www.bre.co.uk/filelibrary/pdf/87741-Cost-of-Poor-Housing-Briefing-Paper-v3.pdf 2 www.local.gov.uk/sites/default/files/documents/5.17%20-%20Housing%20our%20ageing%20 population_07_0.pdf 3 www.gov.uk/government/statistics/english-housing-survey-2014-to-2015-adaptations-and-accessibility-of-The

The examples highlighted in this publication show that councils are innovating to put in place personalised interventions that enable people to live in their homes for longer and promote positive ageing, often in partnership with the voluntary and community sector. We set out practical steps which councils can take to further improve local approaches to home adaptations.

Crucially, some of these steps are about the more efficient use of existing resources and flexibilities, and better partnership working. This is particularly important for the strategic use of the Disabled Facilities Grant (DFG), which requires close working between county councils and district councils in two-tier areas, and alignment to the wider integration aims of the Better Care Fund and health and wellbeing boards.

Whilst there have been some challenges accessing home adaptions during the pandemic, services are getting back to normal and partners are working hard to meet demand. Strengthened local intelligence about people in vulnerable circumstances presents an opportunity for councils to proactively reach more people who would benefit from safer and more accessible homes.

COVID-19 has shown there is an urgent need for government to ensure that councils and local partners have the necessary funding to enable timely and effective home adaptations for older and disabled people, to help ensure their safety, wellbeing and independence during and beyond the pandemic.

Cllr Ian Hudspeth Chair LGA Community Wellbeing Board

Cllr David Renard Chair LGA Environment, Economy, Housing and Transport Board

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Introduction

The Local Government Association (LGA), the Association of Directors of Adult Social Services (ADASS), Care & Repair England and Age UK have produced this guide for councillors and health and wellbeing board members to highlight important aspects of home adaptations and provide links to information about local innovation and good practice. Although this guide focuses on the context of an ageing population, it is important to note that the growing number of working age adults and children with a disability is also increasing demand for adaptations.

The guide covers:

The Disabled Facilities Grant (DFG) is an important source of funding for home adaptations. It is a mandatory grant to help meet the costs of adapting the homes of disabled adults and children. In two-tier areas the DFG requires close working between the county council and district councils. Since the creation of the Better Care Fund (BCF), the DFG has been paid via the BCF. There is a requirement (set out in the current BCF Policy Framework) for adult social care authorities to work with housing authorities to put in place local plans for the DFG that align to wider BCF outcomes as part of a strategic approach to home adaptations.

• why you need to know about home adaptations, including cost benefits and social benefits • key questions for leading councillors for housing, social care and Public Health and health and wellbeing board members when developing or updating local approaches to home adaptations • the role of councils and the voluntary sector’s contribution • what works • resources for further information.

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Why you need to know about home adaptations A large majority of older people (over 90 per cent4) currently live in ordinary, mainstream homes. We also know that 80 per cent of the homes we will be living in by 2050 are already built5 and that 72 per cent of homes could be adapted.6 This means that adapting and improving the current housing stock is a priority in terms of housing and ageing and sits alongside a council’s wider housing and planning role, for example ensuring new build homes are accessible and the sufficiency of specialist housing with care.

Home adaptations have a critical role to play in:

• extending safe, independent living in the home and delaying moves into residential care • efficient, cost effective delivery of health and care services within to home • reducing demand for NHS services/ reducing people delayed in hospital while awaiting home adaptations

There is a growing body of evidence that 7

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• Public Health England published a report in 2018 on falls prevention which found that home adaptations resulted in a 23 per cent reduction in hospital admissions and a financial return of investment of £3.17 for every pound spent. They estimated a social return on investment – which includes the impact of the adaptation on wellbeing – of £7.23 for every £1 spent.8 • The Wales Rapid Response Adaptations programme estimates that £7.50 of health and care costs are saved for every £1 spent on adaptation.9

• supporting older people and disabled people and their carers to manage their health and wellbeing in the home

• prevention of high cost acute incidents, such as falls in the home.

home adaptations can transform the lives of older and disabled people, extending safe, independent living at home and saving health and care costs. For example:

• West of England Care and Repair delivers minor repairs and adaptations for people returning from hospital. An independent review estimated that £13,500 in hospital bed days was saved for a spend of £1000.10 • A review of evidence for the DWP found that home adaptations improved quality of life for 90 per cent of recipients as well as resulting in reduced costs to health and care.11 • The Centre for Ageing Better reviewed international academic evidence12 about

ONS Census Data plus English Housing Survey (annual) Data sources Boardman, B et al (2005) ‘40% House’, Environmental Change Institute, University of Oxford, UK www.gov.uk/government/statistics/english-housing-survey-2014-to-2015-adaptations-and-accessibility-of-homes-report Powell, J. et al (2017) ‘The role of home adaptations in improving later life’ Centre for Ageing Better, London Public Health England (2018) Falls prevention: cost effective commissioning https://gov.uk/government/publications/falls-prevention-cost-effective-commissioning Care and Repair Cmyru (2014) Indicative budget 2015/16 Written evidence for finance committee S. Adams (2017) Reducing delayed transfer of care through housing interventions: evidence of impact Heywood, FS & Turner, L, (2007) Better outcomes, lower costs Office for Disability Issues, University of Bristol and Department for Work and Pension Powell, J. et al (2017) ‘The role of home adaptations in improving later life’ Centre for Ageing Better, London

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the impacts of home adaptations carried out for older people which concluded that speedy provision of home adaptations and meeting the priorities of the individual were critical success factors.

• The NHS Quick Guide to Housing and Health13 highlights that: ◦ 75 per cent of deaths related to falls happens at home and represents 10-25 per cent of ambulance calls to older adults14 ◦ simple home modifications such as installing handrails, and slip-resistant surfaces, resulted in a 39 per cent reduction in injuries and a 26 per cent reduction in medical treatment15 ◦ a Swedish study found ‘for each month’s wait for an adaptation, the person’s difficulties in performing everyday tasks increased.’16

‘No one will ever really understand how much this adaptation has helped us with looking after our son.’

Mr & Mrs D

13 NHS England Quick Guide to Health and Housing accessed 18 September 2018 www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/Quick-Guide-health-and-housing.pdf 14 Wakefield District Council case study quoted by NHS England, accessed 18 September 2018, www.england.nhs.uk/2018/03/nhs-teams-up-with-councils-to-improve-housing-health-with-home-mots-stair-lifts-falls-helplinesand-quick-grants/ 15 Keale MD et al Home Injury Prevention Intervention (HIPI) Study The Lancet (online) 23rd Sept 2014 16 Centre for Ageing Better (2017) The Role of Home Adaptations in improving later life

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Key questions

Councillors with portfolio responsibilities for housing, social care and public health together with health and wellbeing board members might find the following questions useful prompts when developing or updating local approaches to home adaptations.

• To what extent are older people’s and disabled people’s groups/ forums in your area involved in the planning and design of adaptation provision and helping to identify need?

Adaptations delivery

Strategic • To what extent are health, housing and social care working together locally to use adaptations to help enable people to live independently, safely and well in their own homes for longer, thereby helping to reduce demand for local health and care services?

In two-tier areas, how are the county council and district councils working together to achieve this?

• How are Disabled Facilities Grants and wider Better Care Fund plans supporting the achievement of greater independence and wellbeing for residents? In two-tier areas, how are the county council and district councils working together to achieve this?

• Does the housing authority have in place a suitable Regulatory Reform Order (RRO) policy that enables it to use the Disabled Facilities Grant to support preventative health and wellbeing in the home?

• To what extent does the local Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy recognise older people’s need for accessible housing and the requirement to have an effective adaptations service to meet this need?

• Do you know how well home adaptations provision is working in your area and the extent to which it is meeting service users’ needs?

• Are you confident that residents and their families or carers know about possible home adaptations and their benefits, as well as the help available for those who cannot afford to pay?

• Have you considered how your local home adaptations provision could be improved?

For example, a triage system to ensure that straightforward adaptions can be carried out quickly and effectively; linking to hospital discharge, falls and dementia pathways; and working with the voluntary sector to mobilise resources in joined-up support for older people?

• To what extent is your area learning from national good practice models?

‘My nephew, who is my carer, does not have to help me so much’ Mr M (level shower)

• How is your health and wellbeing board encouraging links between housing adaptions delivery and local NHS work on prevention?

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‘Because of the adaptations I can continue to live independently and feel safe in my own home near my family and friends. You can’t believe how much this means to me.’

Mrs H, 78 yrs

The LGA report, Ageing: the silver lining17, noted that: ‘Enabling older people to remain living in their own homes could be aided significantly through the provision of relatively simple practical support... home improvement agencies / handypersons services to undertake aids and adaptations... is vital to this’.

The LGA Housing Commission18 highlighted the crucial role that housing plays in supporting health and wellbeing: ‘The suitability of the housing stock for our ageing population is of critical importance to the health and wellbeing of individuals, and the capacity of public services to sustainably support healthy ageing’ The Commission recommended that local and national government work together to: •

ensure sufficiently funded systems are in place to enable older people to modify their homes to support prevention and positive ageing in ways that generate savings to health and care services

•

plan and deliver housing as part of emerging integrated health and social care services, with activities and facilities designed to support older people to age well in their homes and communities for longer.

‘It has improved my life so much.

I can get out my front door without help.’

Mr A (front door ramp)

17 LGA (2015) Ageing: the silver lining. The opportunities and challenges of an ageing society for local government. London. LGA 18 Building Our Homes, Communities and Future: The LGA Housing Commission Final Report 2016

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Meeting the home adaptation needs of older people

Role of councils and the contribution of the voluntary sector Councils’ community leadership is crucial to enabling older people and people with disabilities to live in decent homes that support their health and wellbeing including: • planning for/ building well designed, accessible and sustainable new general purpose homes • planning for/ building specialist housing for ageing • creating age friendly neighbourhoods, including good transport • facilitating the modification of the existing housing stock, including home timely provision of home adaptations and addressing poor housing standards (eg cold homes, disrepair) Councils with housing responsibilities have a duty to provide help with home adaptations (as set out in legislation and regulations defining the Disabled Facilities Grant system). Councils with responsibilities for social care have legal duties with regard to provision of home adaptations for disabled people, including minor aids and equipment, (under £1,000 and referred to as ‘Community Equipment’) as defined by the Care Act 2014.19 The funding for the Disabled Facilities Grant (DFG) provided by national government has more than doubled, from £220 million in 2013/14 to over £500 million in 2020/21. This has provided an ideal opportunity to review and improve current systems of working between the NHS, social care and housing to enable healthy, safe, independent living at

home for older people. The amount allocated to each council is published each year.20 The statutory duty on local housing authorities to provide DFG to those who qualify for it remains. The 2019-20 BCF Policy Framework is clear that decisions around the use of the DFG funding are expected to be made with the direct involvement of both tiers of local government, and the Clinical Commissioning Groups (CCGs), working together on BCF plans to support wider integration ambitions.

The national government letter allocating DFG funding states that in two tier areas the DFG funds should be paid to district councils (in full, unless jointly agreed to do otherwise) to enable them to continue to meet their statutory duty to provide adaptations and in line with these shared plans.

Other key features of the DFG are: • Average DFG grant is around £9,000 but the majority of awards are much less than this and a few complex adaptations are much higher. The mandatory DFG limit is £30,000 but councils (social services and housing authorities) have significant discretion to provide top up adaptation grants and loans.

• Home owners and tenants can apply for a DFG. There will usually be local arrangements and provision made by social landlords.

• DFG can be means tested for adults but is not means tested for children. The amount of DFG adults are eligible for is dependent upon their income, but not the value of the

19 Department of Health (2014) Care and Support Statutory Guidance. Issued under the Care Act 2014 Section about Preventing, Reducing or Delaying Needs 20 http://careandrepair-england.org.uk/wp-content/uploads/2014/12/180509-ANNEX-A-DFG-Grant-Determination-2018-19-FINAL.pdf

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home. Councils can ask for repayment of a DFG over £5,000 if a person sells the property within 10 years of the adaptation.

• The housing authority assesses whether a particular home adaptation is ‘reasonable and practicable’ and can ask social services to assess whether an adaptation is ‘necessary and appropriate’ to meet the person’s needs as set out in housing law. Occupational therapists carry out many assessments, but increasingly trusted assessors advise on simpler adaptations.21 • The DFG statutory entitlement is not the same as that for social care. Social care prioritisation, such as helping those meeting substantial needs criteria, must not be applied to DFG assessment.

• Local housing authorities have a great deal of discretion with providing grants for home adaptations. Some have simplified, fast track, non-means tested systems to provide smaller adaptations and apply DFG criteria only for larger works.

Through working with CCGs and their local voluntary and community services, councils can also enable adaptation related services to be connected – for example, information and advice, home improvement agency, handy person and trusted traders’ services that make a huge difference to effective adaptation delivery, as well as improving older people’s wellbeing, at relatively low cost, and in a relatively short time.

The voluntary and community sector are important partners in reaching residents who would benefit from support with adaptations as well as helping design services that are effective in meeting this housing need and providing direct support.

Not-for-profit home improvement agencies give: • information, advice and support to older and disabled people who need repairs or adaptations to their homes. This may include assistance of a handyperson, wider housing options information and advice on practical, technical and financial matters related to adapting the home.

• additional adaptations assistance such as Hospital to Home and rapid response adaptations.

Local Age UKs provide: • reach to older people, including those not in touch with council services. Many older people regard them as the ‘go to’ place for impartial help and advice on a wide range of issues. In advising on issues such as benefit entitlement, care services support for loneliness Age UK staff and volunteers can also identify older people who would benefit from housing adaptation and repair and advise them on where they can get help • a person centred, holistic approach which means they can work with the recipients and make sure the scope and pace of adaptation meets the individual’s aspirations and needs, as well as others in the household • a collective voice to represent the views of older people in the area, supporting more effective service design • handy person services and trusted trader lists in some areas.

‘… it has changed my whole life for the better and given me back my independence. For the first time in 12 years we sit downstairs as a family and I am not stuck up in the bedroom.’

Mrs L (through floor lift)

21 For advice on the different roles of occupational therapists and trusted assessors, see www.rcot.co.uk/adaptations-without-delay

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Meeting the home adaptation needs of older people

National Policy Context In December 2014 the LGA joined with more than 25 stakeholders including the NHS, government departments and the voluntary sector, to sign a national Memorandum of Understanding to support a joint commitment to improve health and care services through the home. This was renewed in 2018. 22

‘I don’t struggle so much, my breathing gets very bad, but I’m not taking so much medication or going to the Doctors so much and I don’t get so depressed.

It’s helped me so much.’

Mr G, (stairlift)

In 2018 the Housing, Communities and Local Government Select Committee produced its second report into Housing for Older People23, and recommended the expansion of provision of housing information and advice and the reform of the Disabled Facilities Grant to speed up the process and encourage local innovation.

The APPG on Ageing and Older People carried out an inquiry into decent accessible homes for older people24 and its recommendations included reviewing the Decent Homes Standard to ensure accessible housing that meets the needs of an ageing population and restoring funding for national and local housing advice services.

The 2019 Green Paper on Prevention25 included a section on the importance of the home, including accessible housing and adaptations.

An External Review of the Disabled Facilities Grant, commissioned by MHCLG and DHSC, was published at the end of 2018 with a full evaluation of the available data on the working of the Disabled Facilities Grant and recommendations for how this could be improved.26

22 Improving Health and Care through the Home www.gov.uk/government/publications/imporving-health-and-care-through-the home-mou 23 MHCLG Select Committee Housing for Older People, 2018 https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/370/370.pdf 24 APPG on Ageing and Older People (2019) Inquiry into decent accessible homes for older people 25 DHSC (2019) Advancing Our Health: Prevention in the 2020s Consultation (now closed) 26 University of West England 2018, Disabled Facilities Grant and other adaptations: External Review

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What works

Research carried out by Care & Repair England and the Centre for Ageing Better demonstrates that in many areas councils have been able to take the opportunities opened up by the Better Care Fund to provide high quality, cost effective and streamlined adaptation services27 which:

• links to ‘added value’ services, such as improving health by addressing cold homes.

• raise awareness of what is possible

• integration with health and care

• help older people navigate the system

• planning and forecasting demand

• deliver home adaptations quickly.

• allocation of sufficient financial/staff resources to meet need

A recent report, Adapting for ageing: Good practice and innovation in home adaptations28, identified a range of local innovations and good practice examples about helping older people with home adaptations. The report describes 24 local exemplars and provides links to councils’ housing assistance policies (where available).

The views of older people and their priorities for home adaptations provision were key to defining which factors contribute to making a good home adaptations service. These include:

The following success factors were identified as important for supporting a strategic approach and innovative provision regarding home adaptations for older people:

• systems to evaluate health and care outcomes • culture of continuous improvement.

Overall, the joint commissioning of fast track practical housing services that support independent living at home is an opportunity to ensure that housing is embedded in social care and health assessments. For example, hospital discharge, age related health checks and falls prevention.

• awareness raising, outreach, providing accessible information/ advice

There is also evidence that in many areas more could be done to support older people to live in housing that enables them to live safely and independently. Issues include:

• good communication with service users

• access to impartial information and advice

• advice and help for self-funders

• level of public awareness of adaptation services

• flexibility to reflect individual requirements and circumstances • triage/fast-track initiatives to speed up delivery and ensure that relatively simple and low cost adaptations and equipment such as grab rails, raised toilet seats and seats in baths can be delivered quickly, possibly by trained trusted assessors rather than the much more highly

• making local adaptation systems easier to navigate for local residents as well as professionals and providers • improved waiting times for adaptations assessment, including eligibility for grants and loans.

27 Centre for Ageing Better and Care and Repair England (2018) Adapting for ageing: Good practice and innovations in home adaptations 28 ibid

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Resources for further information and advice Home adaptations good practice The NHS Quick Guide to Housing and Health29 provides practical resources and information about how housing and health can work together to prevent and reduce hospital admissions, length of stay, delayed discharge, readmission rates and ultimately improve outcomes.

The Centre of Ageing Better and Care and Repair England have produced a suite of publications since 2017 on the importance of adaptations, including links to existing good practice.30 In 2019 the Royal College of Occupational Therapists published Adaptations without Delay, exploring the circumstances when Trusted Assessors are able to advise on and manage adaptations and the circumstances when the specialist skills of occupational therapists are required.31 The LGA / ADASS High Impact Change Model32 for the Better Care Fund has been refreshed to include a section on housing which highlights the important role of home adaptations.

National government has commissioned the company Foundations to provide councils with advice about improving their DFG systems and service.33 The Home Adaptations Consortium provides a forum to share and promote good policy and practice.34 This includes a detailed ‘Home Adaptations Challenge check list’35 of questions and indicative responses for anyone who would like to improve local services.

Home adaptations law, guidance and system overviews Home Adaptations Consortium (2013, updated 2015) Home Adaptations for Disabled People: A detailed guide to related legislation, guidance and good practice.

Accessed October 2018.36

‘I live on my own, but it’s given me a new lease of life.’

Mrs P, (stairlift)

29 NHS England Quick Guide to Health and Housing accessed 18 September 2018 www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/Quick-Guide-health-and-housing.pdf 30 Centre for Ageing Better 2018 op cit www.ageing-better.org.uk/publications/adapting-for-ageing 31 Royal College of Occupational Therapists (2019) Adaptations without delay www.rcot.co.uk/news/rcot-launch-adaptations-without-delay-report 32 www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/systems-resilience/refreshing-high 33 www.foundations.uk.com/dfg-adaptations/ 34 https://homeadaptationsconsortium.wordpress.com 35 http://careandrepair-england.org.uk/wp-content/uploads/2019/11/DFG-Challenge-Checklist.pdf 36 https://homeadaptationsconsortium.files.wordpress.com/2013/09/dfg-good-practice-guide-10-september.pdf

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Local Government Ombudsman (2016) Making a house a home: Local authorities and disabled adaptations.37

Related reports about home adaptations

DHSC & MHCLG 2019-20 Better Care Fund: Policy Framework.38

Garrett H et al (2016) The cost-benefit to the NHS arising from preventative housing interventions.

DCLG (2016) English Housing Survey Adaptations and Accessibility Report, 2014-2015.

Mackintosh, S., and Leather, P. (2016) ‘The Disabled Facilities Grant: Before and after the introduction of the Better Care Fund’, Glossop Foundations.

University of West England (2018) Disabled Facilities Grant and Other Adaptations: External Review Care & Repair England (2016) Disabled Facilities Grant: a system of help with home adaptations for disabled people in England– an overview Nottingham Care & Repair England Home Adaptations Consortium– for a range of DFG materials & resources Mandelstam M (2016) Home adaptations: The Care Act 2014 and related provision across the UK London. Royal College of Occupational Therapists Parliamentary Briefing about Disabled Facilities Grant (2013) The House of Commons Library.39

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39 40 41 42 43 44

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Versus Arthritis (2018) Room to Manoeuvre: Why aids and adaptations matter to people with arthritis London Versus Arthritis.

Royal College of Occupational Therapists (2019) Adaptation without delay.

Information and advice for older people about home adaptations Age UK.40 Age UK Factsheet 42 (February 2018) Disability equipment and home adaptations Age UK Factsheet 67 (March 2018) Home Improvements and Repairs Disabled Living Foundation.41 Care & Repair England.42 Elderly Accommodation Counsel.43 Independent Age.44

Local Government Ombudsman (2016) Making a house a home: Local authorities and disabled adaptations www.lgo.org.uk/assets/attach/2815/FR-DFG-March-2016.pdf DHSC & MHCLG 2019-20 Better Care Fund: Policy Framework https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/821676/Better_Care_ Fund_2019-20_Policy_Framework.pdf https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN03011 www.ageuk.org.uk www.dlf.org.uk www.careandrepair-england.org.uk/home-adaptations www.firststopcareadvice.org.uk www.independentage.org

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This is a joint production by LGA, Care & Repair England and Age UK

About Care & Repair England Care & Repair England is a national charity set up in 1986 to improve the housing and living conditions of older people, particularly for those living in poor quality private sector housing and who need help with home repairs and adaptations. It aims to innovate, promote and support practical housing initiatives, and the related policy and practice, which enable older people to live independently in their own homes in greater comfort and security for as long as they choose.45 @cr_england

About Age UK Age UK is a national charity that works with a network of partners, including Age Scotland, Age Cymru, Age NI and local Age UKs across England, to help everyone make the most of later life, whatever their circumstances. In the UK, the Charity helps more than seven million older people each year by providing advice and support. It also researches and campaigns on the issues that matter most to older people. Its work focuses on ensuring that older people: have enough money; enjoy life and feel well; receive high quality health and care; are comfortable, safe and secure at home; and feel valued and able to participate.46

About ADASS The Association of Directors of Adults Social Services is a charity. Our objectives include: • furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time • furthering the interests of those who need social care services regardless of their backgrounds and status • promoting high standards of social care services.

Our members are current and former directors of adult care or social services and their senior staff.

45 www.careandrepair-england.org.uk 46 www.ageuk.org.uk

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